MF2 - Spinal Cord Injury

7/30/2019 MF2 - Spinal Cord Injury

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Spinal Cord Injury (SCI)

Elda Grace G. Anota, MD

Physical Medicine and RehabilitationCebu City


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Anatomy


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Anatomy


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Dermatomes

Total Sensory Index Score (SIS)


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Myotomes

Total Motor Index Score (MIS)


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Causes

Tumors

Infection

Disc disease and Spondylosis Hematoma

Cystic lesions

trauma penetrating, mauling, MVA, falls, sports

injury


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Causes

Tumors

primary or secondary

extradural/intradural/intramedullary


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Causes

Infection

Acute (e.g. staphylococcal)

or chronic (e.g. TB) Potts disease extradural/intradural


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Causes

Disc disease and Spondylosis


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Causes

Hematoma

AVM/spontaneous/trauma

Extradural/intradural/intramedullary


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Causes

Cystic lesions

Extradural

Intradural - arachnoidal Intramedullary - syringomyelia


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Causes

trauma

penetrating, mauling, MVA, falls, sportsinjury


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Manifestations

Depend on:

site of lesion

vascular involvement

speed of onset


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Manifestations

Depend on:

site of lesion


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Manifestations

Depend on:

vascular involvement

Anterior spinal artery

Posterior spinal artery


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Clinical features

Depends on the site and level of thelesion from the level down

sensory impairment

weakness or paralysis

neurogenic bladder

neurogenic bowel

pain


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Spinal Cord Injury (SCI)


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Anterior Cord Syndrome


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Posterior Cord Syndrome


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Central Cord Syndrome


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Brown Sequard Syndrome


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American Spinal Injury Association

(ASIA) Classification

A: complete, no sensory and nomotor function from the SCI leveldown, including the sacral segments

(S4-S5)

B: incomplete, sensory but not motorfunction is preserved below the

neurologic level and includes thesacral segments


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C: incomplete, motor function ispreserved below the neurologic level,and more than half of the key

muscles below the neurologic levelhave a muscle grade /= 3/5


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E: normal, sensory and motorfunction are normal


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Spinal Cord Injury

Morbidity

most common: pressure ulceration

2nd most common: urinary tract infection

Early mortality during the 1st year after the injury

most common: pneumonia

non-ischemic heart disease, pulmonaryembolism

*increased frequency in SCI: pulmonaryembolism, sepsis, pneumonia


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Spinal Cord Injury

Late Mortality surviving > 5 years

3 most common cause of death:

pneumonia, non-ischemic heart disease,inintentional injury

*increased incidence in SCI: sepsis (dueto UTI, pressure ulcers, pneumonia),

pneumonia, UTI


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Spinal Cord Injury

Life expectancy

increased in the past decades

lower than normal


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Diagnostics

Imaging studies sagittal, transverse

MRI

CT scan X-ray

Somatosensory Evoked Potentials

(SSEP) CSF analysis


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Diagnostics

Imaging studies sagittal, transverse

MRI AP, lateral, oblique

CT scan sagittal, transverse

X-ray sagittal, transverse


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Diagnostics - Imaging


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Diagnostics - Imaging


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Diagnostics

Somatosensory Evoked Potentials(SSEP)


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Diagnostics

CSF analysis


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Conditions/Problems in SCI

Pulmonary problems

atelectasis, pneumonia

ventilatory failure

GIT problems

gastric atony, hyperkalemia

gastrointestinal bleeding

superior mesenteric artery syndrome


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Cardiac Problems Levels of increase in HR and O2 uptake during

exercise are lower than normal due to lessfunctioning muscle mass, poor venous return,poor ventilatory dynamics

Tetraplegics: impaired autonomic response whichlimit HR elevation (chronotropic and inotropic),catecholamine production, thermoregulation

Decr exercise capacity decr HDL levelsincr risk for CV diseases

Orthostatic hypotension, bradyarrythmias

Deep Venous Thrombosis and PulmonaryEmbolism


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Heterotropic Ossification

Deposition of new bone around ajoint\potentials loss of joint range

Most common: Hip > knee

Noted 19 days to several years (1-4months)

SSx: joint swelling, heat, fever,

peripheral neuropathy


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Pain

radicular, central, visceral, musculoskeletal,psychogenic

Osteoporosis, Pathologic fracture Autonomic Dysreflexia

unique to SCI patients

SSx: headache, hypertension, nasal

congestion, diaphoresis, piloerection,tachycardia or bradycardia, flushing

Upper Extremity pain and overuse

shoulder pain, UE neuropathies


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Management

Acute Goal: prevent or minimize any resulting

neurologic deficit

Supporting the spine (immobilization) duringtransport and transfers

Diagnostics

Medical management steroids within 8 hours of injury

airway, breathing, circulation urethral catheter

Surgical management if necessary instrumentation

bone grafting


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Spine surgery


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Management

Chronic

Rehabilitation management

exercises

orthosis

assistive device

work simplification techniques

energy conservation techniques

patient education

caregiver education

psychology


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Sensory level

Motor level

Sensorimotor level

Beevors sign


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Other conditions

Cauda Equina Syndrome

Bends disease/Caissonsdisease/Decompression sickness

Documents

MF2 - Spinal Cord Injury